How to Know if Your Child Has a Voice Disorder

Speech and Language Delay and DisorderWhat are speech/language delays and disorders?

Speech is the sound that comes out of our mouths.  When it is not understood by others there is a problem.  Speech problems, such as stuttering and mispronunciation can be very frustrating.

Language has to do with meanings, rather than sounds.  Language is a measure of intelligence and language delays are more serious than speech problems.

Language delay is when a child’s language is developing in the right sequence, but at a slower rate.  Speech and language disorder describes abnormal language development.  Delayed speech or language development is the most common developmental problem.  It affects five to ten percent of preschool kids.

How can I tell if my child’s speech and language development is on track?

If your child is not on track with the following speech/language development milestones, you should talk to your pediatrician.

Here are the milestones to look for in normal speech development:

Age Language Level
Birth Cries
2-3 months Cries differently in different circumstances; coos in response to you
3-4 months Babbles randomly
5-6 months Babbles rhythmically
6-11 months Babbles in imitation of real speech, with expression
12 months Says 1-2 words; recognizes name; imitates familiar sounds; understands simple instructions
18 months Uses 5-20 words, including names
Between 1 and 2 years Says 2-word sentences; vocabulary is growing; waves goodbye; makes “sounds” of familiar animals; uses words (like “more”) to make wants known; understands “no”
Between 2 and 3 years Identifies body parts; calls self “me” instead of name; combines nouns and verbs; has a 450 word vocabulary; uses short sentences; matches 3-4 colors, knows big and little; likes to hear same story repeated; forms some plurals
Between 3 and 4 years Can tell a story; sentence length of 4-5 words; vocabulary of about 1000 words; knows last name, name of street, several nursery rhymes
Between 4 and 5 years Sentence length of 4-5 words; uses past tense; vocabulary of about 1500 words; identifies colors, shapes; asks many questions like “why?” and “who?”
Between 5 and 6 years Sentence length of 5-6 words; vocabulary of about 2000 words; can tell you what objects are made of; knows spatial relations (like “on top” and “far”); knows address; understands same and different; identifies a penny, nickel and dime; counts ten things; knows right and left hand; uses all types of sentences

If your child is not meeting these milestones, the first step is to get their hearing checked.  Even if they seem to hear just fine, kids are experts at picking up visual cues to get by.  It’s important to catch hearing loss early, so that treatment begins as soon as possible.

How can I tell if my child has a language problem or is just “late-bloomer”

You can’t really tell whether a child with delayed speech is a late bloomer or has an expressive language disorder or other underlying cause of speech delay.  That’s why it’s worth seeking help.  The earlier your child gets help, the greater their progress will be.  And if they turn out to be a late bloomer, the extra attention to their speech will not have hurt in any way.

What causes speech and language problems?

Developmental speech and language disorder is a common reason for speech/language problems in kids.  This is a learning disability that is caused by the brain working differently.    These kids may have trouble producing speech sounds, using spoken language to communicate, or understanding what other people say.  Speech and language problems are often the earliest sign of a learning disability.

Hearing loss is often overlooked, and easily identified.  If your child is speech/language delayed, their hearing should be tested.

Intellectual disabililty is a common cause of speech and language delay.

Extreme environmental deprivation can cause speech delay.  If a child is neglected or abused and does not hear others speaking, they will not learn to speak.

Prematurity can lead to many kinds of developmental delays, including speech/language problems.

Auditory Processing Disorder describes a problem with decoding speech sounds.  These kids can improve with speech and language therapy.

Neurological problems like cerebral palsy, muscular dystrophy, and traumatic brain injury can affect the muscles needed for speaking.

Autism affects communication.  Speech/language/communication problems are often an early sign of autism.

Structural problems like cleft lip or cleft palate can interfere with normal speech.

Apraxia of speech is a specific speech disorder in which the child has difficulty in sequencing and executing speech movements.

Selective mutism is when a child will not talk at all in certain situations, often school.

How can my child communicate, if not verbally? 
Children who are nonverbal, or not communicating well enough due to hearing loss, autism, apraxia, or similar problems, can use other methods.  These include sign language, the Picture Exchange Communication System (PECS), and Augmentative and Alternative Communication.

How can I help my child with language development?
It is important to identify speech/language problems early, so your child can begin treatment. Many people believe that speech and language treatment cannot begin until a child starts talking.  This is not true.  Treatment can and should begin as soon as possible.  Research shows that children know a lot about language long before the first word is ever said.

If your child has any risk factors (for example low birth weight) or any of the problems listed above, they should be tested early and periodically for speech/language problems.  If your child needs treatment, it should be developmentally appropriate and individualized.  Your child’s treatment team might include a doctor, an audiologist, a speech-language pathologist, an occupational therapist, and/or a social worker.

Be sure to read Your Child: Learning Disabilities or Developmental Delay for information about how the school system can help your baby, preschooler, or school-age child if you have speech or language concerns.

Here are some parenting tips for helping along your child’s speech and language:

  • Start talking to your child at birth.  Even newborns benefit from hearing speech.
  • Respond to your baby’s coos and babbling.
  • Play simple games with your baby like peek-a-boo and patty-cake.
  • Listen to your child. Look at them when they talk to you. Give them time to respond. (It feels like an eternity, but count to 5—or even 10—before filling the silence).
  • Describe for your child what they are doing, feeling and hearing in the course of the day.
  • Encourage storytelling and sharing information.
  • Don’t try to force your child to speak.
  • Read books aloud.  Ask a librarian for books appropriate to your child’s age. If your baby loses interest in the text, just talk about the pictures.
  • Sing to your child and provide them with music.  Learning new songs helps your child learn new words, and uses memory skills, listening skills, and expression of ideas with words.
  • Expand on what your child says.  (For example, if your child says, “Elmo!”, you can say, “You want Elmo!”)
  • Talk a lot to your child.  Tell them what you are doing as you do it.
  • Plan family trips and outings.  Your new experiences give you something interesting to talk about before, during, and after the outing.
  • Look at family photos and talk about them.
  • Answer your child every time they speak—this rewards them for talking.
  • Ask your child lots of questions.
  • Use gestures along with words.
  • Don’t criticize grammar mistakes.  Instead, just model good grammar.
  • Play with your child one-on-one, and talk about the toys and games you are playing.
  • Follow your child’s lead, so you are doing activities that hold their interest as you talk.
  • Have your child play with kids whose language is a little better than theirs.

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